Provider Demographics
NPI:1942394325
Name:LUNA, ALICE M (MD)
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:M
Last Name:LUNA
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:PO BOX 26666
Mailing Address - Street 2:PHS PROVIDER ENROLLMENT
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87125-6666
Mailing Address - Country:US
Mailing Address - Phone:505-923-6770
Mailing Address - Fax:505-923-5354
Practice Address - Street 1:5901 HARPER DR NE
Practice Address - Street 2:PMG NORTHSIDE
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-3587
Practice Address - Country:US
Practice Address - Phone:505-923-8282
Practice Address - Fax:505-823-8275
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2016-03-24
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Provider Licenses
StateLicense IDTaxonomies
NM78210208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM19224Medicaid
NM19224Medicaid